Body mass characteristics of hip osteoarthritis patients experiencing aseptic loosening, periprosthetic fractures, dislocation, and infections after total hip replacement

Figures & data

Table 1 Table depicting study findings as regards the role of body mass in the context of hip joint osteoarthritis in general

Authors	Study topic + sample	Findings
Changulani et al^Citation40	Studied the relationship between obesity and age of hip replacements	Those who were morbidly obese were 10 years younger on average than those with a normal body mass
Flugsrud et al^Citation9	Studied nine years of data on 50,034 participants from cardiovascular screening	There were dose-response associations between body mass indices, body weight, level of physical activity at work and total hip replacement for primary osteoarthritis of the hip
Harms et al^Citation10	Retrospective review of medical charts of patients 18–59 years old, who underwent knee or hip replacement from January 2002–December 2004	Obesity was significantly associated with the need for both forms of surgery compared to age matched healthy controls
Jacobsen and Holm^Citation8	This prospective study investigated the relationships among hip osteoarthritis and body mass among other factors among 4151 subjects from 1976–2003	The risk of total hip replacement was predicted only by body mass indices at baseline
Järvholm et al^Citation41	This study examined the need for total hip replacement in relation to normal range and high body mass among 320,192 male construction workers	Body mass is an important predictor of osteoarthritis, especially osteoarthritis of the hip

Table 2 Table depicting global rates and major categories and related sub-categories and rates of occurrence among these major diagnostic groups plus the mean age of each major group as observed among 1040 hospitalized patients with primary or secondary total hip replacement diagnoses showing different types of complications and reasons for hospitalization, as well as subtle differences in mean ages across conditions

Surgical category	N	Freq (%)	Mean age (Yrs)
Revision surgery	132	12.7	66.82 ± 14.45
Dislocations	17	[12.9]	66.87 ± 11.53
Periprosthetic fractures	8	[6.1]	71.25 ± 15.39*
Prosthetic fractures	2	[1.5]	72.77 ± 12.99*
Periprosthetic cysts	1	[0.8]	48.0
Failure, Loosening	66	[50]
Prosthetic removal	28	2.7	62.31 ± 13.20
Infection diagnosis	17	[60.7]
Prosthetic reimplantation	14	1.4	64.42 ± 10.32
Infection diagnosis	10	[71.4]
Periprosthetic fracture	1
Relocation	4	0.4	65 ± 12.86
Dislocation	2	[50]
Infection	1	[25]
Debridement	3	0.3	28.33 ± 10.12*
Infection diagnosis	3	[100]
Contralateral hip replacement	60	5.7	70.00 ± 8.90
Uncomplicated primary surgery	791	76.0	61.70 ± 11.37
Primary unilateral cases	737
Primary bilateral cases	54

Notes: Rates for items described in italics refer to their frequency of occurrence in the major listed category. Some numbers may be missing from sub categories because of insufficient descriptors of the surgical condition on the chart.

* Significantly different from no complications and removals at the 0.05 level.

Figure 1 Body mass indices of hip osteoarthritis cases categorized by surgical requirements showing significant differences (p < 0.05) between those requiring reimplantation or removal and those requiring relocation due to dislocation.

Figure 2 Body mass index profiles for subcategories of hip osteoarthritis patients showing breakdown of weight status across selected subgroups of hip osteoarthritis surgical candidates.

Table 3 Table depicting study findings as regards the role of body mass in the context of complications following total hip replacement surgery

Authors	Study topic + sample	Findings	Conclusion
Choong et al^Citation21	The authors analyzed the association between patient-related and surgical factors and the risk of infection associated with hip prosthetic surgery in the acute stage among 14 patients of 819 seen between 1998 and 2004	There was a correlation between having a body mass index greater than 30, as well as two co-morbidities and infection	Diabetes and high body mass are possible risk factors that influence the onset of early infection after primary hip arthroplasty
Dowsey and Choong^Citation22	The authors reviewed 1207 consecutive primary hip arthroplasties separating patients into four weight related groups, normal, overweight, obese, and morbidly obese, and compared the incidence of periprosthetic infection between the groups	There was a significantly higher infection rate in obese patients, independent of comorbidities such as diabetes and cardiovascular disease	Obesity is an independent risk factor for acute periprosthetic infection after primary hip arthroplasty
Järvholm et al^Citation41	This study examined the need for total hip replacement in relation to normal range and high body mass among 320,192 male construction workers	Body mass is an important predictor of osteoarthritis, especially osteoarthritis of the hip	Body mass is an important predictor of osteoarthritis even within normal body mass
Kessler and Käfer^Citation29	67 total hip replacement patients of varying weights were assessed 10 days and three months after surgery	There was no significant impact on hospital duration or early outcome based on weight	Body weight should not be justification for withholding surgery from overweight or obese patients
Kim et al^Citation32	Studied the outcomes of revision total hip arthroplasty in a matched cohort of obese and nonobese patients	Seven patients in obese group underwent revision surgery, six of whom underwent additional reoperations to treat recurrent postoperative dislocation	Obese patients should be counseled about the increased risk of dislocation that can occur after revision total hip arthroplasty
Lübbeke et al^Citation13	A hospital-based cohort who underwent total hip replacement or revision total hip arthroplasty was assessed	Patients undergoing revision were older, more often obese, and had more medical and orthopedic comorbidities	Patients and physicians should acknowledge risks that prevail for total hip arthroplasty revision if they are obese
Lübbeke et al^Citation25	Studied the effect of obesity on the incidence of adverse events and selected outcomes after revision total hip arthroplasty	The incidence rate for one or more complications increased with rising body mass indices, especially in the obese range	There is an increased risk of surgical infection and dislocation in obese patients undergoing revision total hip arthroplasty
Münger et al^Citation33	725 cases in a multinational sample collected over 25 years were studied to examined patient-related risk factors leading to aseptic stem loosening in total hip arthroplasty	Height and weight were not associated with loosening, but a higher body mass index was associated with an increased risk of stem loosening	High activity levels, coupled with high body mass indices heighten the risk of stem loosening within 10 years
Pulido et al^Citation24	Reviewed data on 9245 patients undergoing primary hip or knee arthroplasty between January 2001 and April 2006	Prosthetic joint infections occurred in 63 patients or 0.7%, commonly within the first year	An important predictor for prosthetic infection was morbid obesity, among other factors
Sadr Azodi et al^Citation14	A cohort of 2106 male patients who underwent total hip replacement between 1997 and 2004 were identified	53 developed dislocation within three years of follow-up, and these cases were more likely to be overweight or obese	Greater attention should be given to high body mass as a risk factor for dislocation following total hip replacement

Figure 3 Possible role of obesity in mediating complications post-hip replacement surgery among hip osteoarthritis patients.

Figure 4 Possible role of low body mass in mediating complications post-hip replacement surgery among hip osteoarthritis patients.

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